Response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory ranibizumab

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Recent reports demonstrated that large retinal pigment epithelial detachments (PED) associated with neovascular age-related macular degeneration (AMD) was successfully treated with aflibercept. The aim of this study is to report unexpected short-term response of aflibercept in the treatment of AMD with associated large PED which had been failed to ranibizumab treatment.


The method comprised a retrospective review of the medical records of patients with PEDs associated neovascular AMD and recently treated with aflibercept and previously treated with ranibizumab.


Two eyes of male Japanese patients of ages 79 and 80 years old with large serous PEDs and subretinal fluid (SRF) associated with occult choroidal neovascularization and neovascular AMD were treated with aflibercept after intravitreal ranibizumab had failed to resolve the lesions. All had complete resolution of SRF and complete or near- complete resolution of the serous PEDs after aflibercept injections over a 2-month period. However, after the second injection of aflibercep, all eyes displayed fibrovascular PED in the lesion where serous PED was observed. Moreover, one eye presented a sudden retinal hemorrhage and a recurrent PED just after the third injection of aflibercept, and the visual acuity decreased 10/20 to 2/20.


Intravitreal aflibercept may be carefully applied for for serous PED in neovascular AMD patients after ranibizumab have previously failed. Larger studies with longer follow-up are required to determine the role of aflibercept in treatment of serous PED in neovascular AMD.

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